Sunday, May 5, 2013


Although this post is primarily for the ladies, any fellow whose beloved may need this procedure may wish to read it.

A while ago I had an abnormal mammogram. A region in my left breast developed a cluster of calcifications. Standard of care seems to be anywhere from 'repeat in 6 months' to immediate biopsy.  I split the difference and waited to have the biopsy done until after I had some problematic trees trimmed.  Because there was no 'lump', the biopsy required use of imaging technology to ensure that the right stuff was sampled.  The procedure is called "stereotactic biopsy."

Reading about the procedure made it sound pretty straight-forward. I went to the state university's breast clinic, expecting the latest technology.  I don't think I got it.  The rig was a regular mammography system that had a special platform for stereotactic biopsies.  Ideally, after positioning you so the target is visible in the images, the robotic biopsy equipment is added and the process is completed.

After explaining the procedure ad nauseum and getting signatures for every aspect of informed consent, we got started. The technician futzed around with my breast in the booby-smasher for about an hour before realizing that the position she started with, me lying in an uncomfortable position, would not work due to the thickness of the tissue.  There was no way for the biopsy apparatus to fit on the machine. Seems like she could have figured that out before doing all the extra smashing.

Next was sitting in an adjustable chair and doing the same thing again. Finally got the calcified area in the right location and the MD entered. We had spoken prior to the lengthy smashing session, and I had confidence in her, but not so much in the technician. That trend continued.

Dr. C quickly numbed the area deep into the breast tissue, which was a good thing. In advance, all warned that this would be uncomfortable and may burn. The warning, at least for me, was overblown. That part of the process was probably less noticeable than a flu shot. 

With that part done, the biopsy apparatus was placed and centered above the target spot. Dr. C made a small incision in my skin so the biopsy "needle" would enter straight and not rip my skin.  The needle for a core biopsy is different from the one used for an aspiration biopsy. A core needle takes a cylinder of tissue that preserves the relationships between the calcification and the surrounding tissue. To do that, there is essentially a needle within a needle, allowing the cylinder of tissue to be cleanly removed.  To do this, the biopsy needle is rather large, almost the size of a #2 pencil.  Yup, it's a harpoon.

I was doing fine as the biopsy started, but then primal physiology asserted itself.  I had what's called a vasovagal reaction.  It's a primitive neurological response to trauma, probably the same process that we call 'shock.' Got the white clouds, sweats, crashing blood pressure, etc.  Felt really not so good.  Meantime, I'm harpooned, pinned at the left boob to this apparatus and unable to do the thing I wanted to do most, which was faint.

I was aware of what was happening and mentioned the phenomenon to the MD, who coached me through.  She helped me manage my breathing while she positioned and started the robotic part of the core process.  If we stopped, it would have been a nightmare. I'd probably have needed to return in a few weeks for a repeat.  No thanks!

Once she had the cores and withdrew the needle, it took the technician about 4 requests from the MD to lie the chair back.  Tech couldn't find Kleenex or anything else to help with the profuse sweating.  MD then directed her to provide a washcloth with cool water for me. After the third request from the MD,  I got one that was piping hot. Fortunately the air conditioning in the clinic was set to 'polar' so it cooled quickly and I could feel my blood pressure coming back up. After about 20 minutes I could see faces again, where only sparkly blanks had been.

Follwing the procedure, you get wrapped in a wide ace bandage for some pressure on the wounded area to reduce internal bleeding. More instructions for your recovery are provided.

I should have my results by the middle of next week. Most calcifications are benign, but a small percentage reflect a specific type of cancer in the duct tissue.

Here are my lessons learned from the process:

1. Don't assume the latest technology from the local university medical center. If I had to do it again, I'd probably do a little more research on what the latest technology is and where to get it. 

2. Pay attention to the technician. If they seem less than exceptionally competent, ask to see the MD and get a change of personnel.  I'll be writing a letter to the university about this one.

3. Pay attention to yourself. Make sure you eat something somewhat substantial with lots of protein that will keep your blood sugar up during the procedure. I followed the directions to have a light breakfast an hour before the procedure. Unfortunately, the appointment was at 9 a.m. and the actual procedure didn't start until almost 1130. At that point it had been 3.5 hours and my blood sugar was dropping.  I suspect the intensity of the vasovagal reaction would have been less if I'd had higher blood sugar.

4. The process is uncomfortable but no more painful than your regular mammogram plus a flu shot.  Don't dread it or put it off unnecessarily.  I was within the 6 month window of the initial recommendation from the radiologist despite taking the extra month to get a crew in to trim my trees.

5. Follow all the directions for preparation and recovery.  Don't schedule the procedure right before heading out to your ski vacation or your wilderness canoe trip.  Really bad idea.  Unlike my normal behavior, I am following the directions and resisting the temptation to do more sooner. So far neither the pain nor the bruising are uncomfortable.  I've been wearing a snug sports bra (including during sleep) since taking off the ace bandage wrap 24 hours after the procedure. The sports bra reduces any jiggle that could restart internal bleeding.

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